Cardiovascular Screening Practices and Statin Prescription Habits in Patients with Psoriasis among Dermatologists, Rheumatologists and Primary Care Physicians

Authors

  • Emilio Berna-Rico Department of Dermatology, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain
  • Carlota Abbad-Jaime de Aragon Department of Dermatology, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain
  • Angel Garcia-Aparicio Department of Rheumatology, Hospital Universitario de Toledo, Toledo, Spain
  • David Palacios-Martinez Centro de Salud Universitario Isabel II, Parla, Madrid, Spain
  • Asuncion Ballester-Martinez Department of Dermatology, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain
  • Jose-M Carrascosa Department of Dermatology, Hospital Universitari Germans Trias i Pujol. Universitat Autònoma de Barcelona. IGTP. Badalona, Spain
  • Pablo de la Cueva Department of Dermatology, Infanta Leonor Hospital, Madrid, Spain
  • Cristina Anton Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
  • Carlos Azcarraga-Llobet Department of Dermatology, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain
  • Emilio Garcia-Mouronte Department of Dermatology, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain
  • Belen de Nicolas-Ruanes Department of Dermatology, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain
  • Lluis Puig Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
  • Pedro Jaen Department of Dermatology, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain
  • Nehal N. Mehta Laboratory of Inflammation & Cardiometabolic diseases, Cardiovascular Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
  • Joel M. Gelfand Department of Dermatology and Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
  • Alvaro Gonzalez-Cantero Department of Dermatology, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain; Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain

DOI:

https://doi.org/10.2340/actadv.v103.5087

Keywords:

psoriasis, cardiovascular disease, diagnosis, hearth disease risk factor

Abstract

Patients with psoriasis have a higher prevalence of cardiovascular risk factors. This study evaluated cardiovascular screening practices and statin prescribing habits among dermatologists, rheumatologists and primary care physicians (PCPs) through an online questionnaire, which was distributed through the Spanish scientific societies of the above-mentioned specialties. A total of 299 physicians (103 dermatologists, 94 rheumatologists and 102 PCPs) responded to the questionnaire. Of these, 74.6% reported screening for smoking, 37.8% for hypertension, 80.3% for dyslipidaemia, and 79.6% for diabetes mellitus. Notably, only 28.4% performed global screening, defined as screening for smoking, hypertension, dyslipidaemia, and diabetes mellitus by the same physician, and 24.4% reported calculating 10-year cardiovascular disease (CVD) risk, probably reflecting a lack of comprehensive cardiovascular risk assessment in these patients. This study also identified unmet needs for awareness of cardiovascular comorbidities in psoriasis and corresponding screening and treatment recommendations among PCPs. Of PCPs, 61.2% reported not being aware of the association between psoriasis and CVD and/or not being aware of its screening recommendations, and 67.6% did not consider psoriasis as a risk-enhancing factor when deciding on statin prescription. Thirteen dermatologists (12.6%) and 35 rheumatologists (37.2%) reported prescribing statins. Among those who do not prescribe, 49.7% would be willing to start their prescription. 

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References

Lerman JB, Joshi AA, Chaturvedi A, Aberra TM, Dey AK, Rodante JA, et al. Coronary plaque characterization in psoriasis reveals high-risk features that improve after treatment in a prospective observational study. Circulation 2017; 136: 263-276.

https://doi.org/10.1161/CIRCULATIONAHA.116.026859 DOI: https://doi.org/10.1161/CIRCULATIONAHA.116.026859

Gonzalez-Cantero A, Gonzalez-Cantero J, Sanchez-Moya AI, Perez-Hortet C, Arias-Santiago S, Schoendorff-Ortega C, et al. Subclinical atherosclerosis in psoriasis. Usefulness of femoral artery ultrasound for the diagnosis, and analysis of its relationship with insulin resistance. PloS One 2019; 14: e0211808.

https://doi.org/10.1371/journal.pone.0211808 DOI: https://doi.org/10.1371/journal.pone.0211808

Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriasis. JAMA 2006; 296: 1735.

https://doi.org/10.1001/jama.296.14.1735 DOI: https://doi.org/10.1001/jama.296.14.1735

Gelfand JM, Dommasch ED, Shin DB, Azfar RS, Kurd SK, Wang X, et al. The risk of stroke in patients with psoriasis. J Invest Dermatol 2009; 129: 2411-2418.

https://doi.org/10.1038/jid.2009.112 DOI: https://doi.org/10.1038/jid.2009.112

Dhana A, Yen H, Yen H, Cho E. All-cause and cause-specific mortality in psoriasis: a systematic review and meta-analysis. J Am Acad Dermatol 2019; 80: 1332-1343.

https://doi.org/10.1016/j.jaad.2018.12.037 DOI: https://doi.org/10.1016/j.jaad.2018.12.037

Samarasekera EJ, Neilson JM, Warren RB, Parnham J, Smith CH. Incidence of cardiovascular disease in individuals with psoriasis: a systematic review and meta-analysis. J Invest Dermatol 2013; 133: 2340-2346.

https://doi.org/10.1038/jid.2013.149 DOI: https://doi.org/10.1038/jid.2013.149

Karbach S, Hobohm L, Wild J, Münzel T, Gori T, Wegner J, et al. Impact of psoriasis on mortality rate and outcome in myocardial infarction. J Am Heart Assoc 2020; 9.

https://doi.org/10.1161/JAHA.120.016956 DOI: https://doi.org/10.1161/JAHA.120.016956

Garshick MS, Barrett TJ, Wechter T, Azarchi S, Scher JU, Neimann A, et al. Inflammasome signaling and impaired vascular health in psoriasis. Arterioscler Thromb Vasc Biol 2019; 39: 787-798.

https://doi.org/10.1161/ATVBAHA.118.312246 DOI: https://doi.org/10.1161/ATVBAHA.118.312246

Karbach S, Croxford AL, Oelze M, Schüler R, Minwegen D, Wegner J, et al. Interleukin 17 drives vascular inflammation, endothelial dysfunction, and arterial hypertension in psoriasis-like skin disease. Arterioscler Thromb Vasc Biol 2014; 34: 2658-2668.

https://doi.org/10.1161/ATVBAHA.114.304108 DOI: https://doi.org/10.1161/ATVBAHA.114.304108

Mehta NN, Teague HL, Swindell WR, Baumer Y, Ward NL, Xing X, et al. IFN-γ and TNF-α synergism may provide a link between psoriasis and inflammatory atherogenesis. Sci Rep 2017; 7: 13831.

https://doi.org/10.1038/s41598-017-14365-1 DOI: https://doi.org/10.1038/s41598-017-14365-1

Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB, Gelfand JM. Prevalence of cardiovascular risk factors in patients with psoriasis. J Am Acad Dermatol 2006; 55: 829-835.

https://doi.org/10.1016/j.jaad.2006.08.040 DOI: https://doi.org/10.1016/j.jaad.2006.08.040

Armstrong AW, Harskamp CT, Armstrong EJ. Psoriasis and metabolic syndrome: a systematic review and meta-analysis of observational studies. J Am Acad Dermatol 2013; 68: 654-662.

https://doi.org/10.1016/j.jaad.2012.08.015 DOI: https://doi.org/10.1016/j.jaad.2012.08.015

Armstrong AW, Harskamp CT, Dhillon JS, Armstrong EJ. Psoriasis and smoking: a systematic review and meta-analysis. Br J Dermatol 2014; 170: 304-314.

https://doi.org/10.1111/bjd.12670 DOI: https://doi.org/10.1111/bjd.12670

Zheng Q, Sun XY, Miao X, Xu R, Ma T, Zhang YN, et al. Association between physical activity and risk of prevalent psoriasis: a MOOSE-compliant meta-analysis. Medicine (Baltimore) 2018; 97: e11394.

https://doi.org/10.1097/MD.0000000000011394 DOI: https://doi.org/10.1097/MD.0000000000011394

Langan SM, Seminara NM, Shin DB, Troxel AB, Kimmel SE, Mehta NN, et al. Prevalence of metabolic syndrome in patients with psoriasis: a population-based study in the United Kingdom. J Invest Dermatol 2012; 132: 556-562.

https://doi.org/10.1038/jid.2011.365 DOI: https://doi.org/10.1038/jid.2011.365

Wan MT, Shin DB, Hubbard RA, Noe MH, Mehta NN, Gelfand JM. Psoriasis and the risk of diabetes: a prospective population-based cohort study. J Am Acad Dermatol 2018; 78: 315-322.e311.

https://doi.org/10.1016/j.jaad.2017.10.050 DOI: https://doi.org/10.1016/j.jaad.2017.10.050

Takeshita J, Wang S, Shin DB, Mehta NN, Kimmel SE, Margolis DJ, et al. Effect of psoriasis severity on hypertension control. JAMA Dermatol 2015; 151: 161.

https://doi.org/10.1001/jamadermatol.2014.2094 DOI: https://doi.org/10.1001/jamadermatol.2014.2094

Rutter MK, Kane K, Lunt M, Cordingley L, Littlewood A, Young HS, et al. Primary care-based screening for cardiovascular risk factors in patients with psoriasis. Br J Dermatol 2016; 175: 348-356.

https://doi.org/10.1111/bjd.14557 DOI: https://doi.org/10.1111/bjd.14557

Cea-Calvo L, Vanaclocha F, Belinchón I, Rincón Ó, Juliá B, Puig L. Underdiagnosis of cardiovascular risk factors in outpatients with psoriasis followed at hospital dermatology offices: the PSO-RISK study. Acta Derm Venereol 2016; 96: 972-973.

https://doi.org/10.2340/00015555-2434 DOI: https://doi.org/10.2340/00015555-2434

Eder L, Harvey P, Chandran V, Rosen CF, Dutz J, Elder JT, et al. Gaps in diagnosis and treatment of cardiovascular risk factors in patients with psoriatic disease: an international multicenter study. J Rheumatol 2018; 45: 378-384.

https://doi.org/10.3899/jrheum.170379 DOI: https://doi.org/10.3899/jrheum.170379

Elmets CA, Leonardi CL, Davis DMR, Gelfand JM, Lichten J, Mehta NN, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol 2019; 80: 1073-1113.

https://doi.org/10.1016/j.jaad.2018.11.058 DOI: https://doi.org/10.1016/j.jaad.2018.11.058

Dauden E, Blasco AJ, Bonanad C, Botella R, Carrascosa JM, González-Parra E, et al. Position statement for the management of comorbidities in psoriasis. J Eur Acad Dermatol Venereol 2018; 32: 2058-2073.

https://doi.org/10.1111/jdv.15177 DOI: https://doi.org/10.1111/jdv.15177

Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 140.

https://doi.org/10.1161/CIR.0000000000000678 DOI: https://doi.org/10.1161/CIR.0000000000000678

Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021; 42: 3227-3337.

https://doi.org/10.1093/eurheartj/ehab484 DOI: https://doi.org/10.1093/eurheartj/ehab484

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39: 3021-3104. DOI: https://doi.org/10.1093/eurheartj/ehy439

https://doi.org/10.1093/eurheartj/ehy339 DOI: https://doi.org/10.1093/eurheartj/ehy339

Siu AL; U.S. Preventive Services Task Force. Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2015; 163: 778-786.

https://doi.org/10.7326/M15-2223 DOI: https://doi.org/10.7326/M15-2223

Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Atherosclerosis 2019; 290: 140-205. DOI: https://doi.org/10.15829/1560-4071-2020-3826

https://doi.org/10.1016/j.atherosclerosis.2019.08.014 DOI: https://doi.org/10.1016/j.atherosclerosis.2019.08.014

Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 139: e1082-e1143.

https://doi.org/10.1161/CIR.0000000000000624 DOI: https://doi.org/10.1161/CIR.0000000000000624

Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease. Endocr Pract 2017; 23: 1-87. DOI: https://doi.org/10.4158/EP171764.GL

https://doi.org/10.4158/EP171764.APPGL DOI: https://doi.org/10.4158/EP171764.APPGL

American Diabetes Association. 2.Classification and diagnosis of diabetes: standards of medical care in diabetes - 2019. Diabetes Care 2019; 42: S13-s28.

https://doi.org/10.2337/dc19-S002 DOI: https://doi.org/10.2337/dc19-S002

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453-1457.

https://doi.org/10.1016/S0140-6736(07)61602-X DOI: https://doi.org/10.1016/S0140-6736(07)61602-X

American Association for Public Opinion Research. Survey disclosure checklist. May 13, 2019. [Accessed 2022, Feb 3]. Available from: https://www.aapor.org/Standards-Ethics/AAPOR-Code-of-Ethics/Survey-Disclosure-Checklist.aspx.

Zhang Z. Model building strategy for logistic regression: purposeful selection. Ann Transl Med 2016; 4: 111.

https://doi.org/10.21037/atm.2016.02.15 DOI: https://doi.org/10.21037/atm.2016.02.15

Parsi KK, Brezinski EA, Lin TC, Li CS, Armstrong AW. Are patients with psoriasis being screened for cardiovascular risk factors? A study of screening practices and awareness among primary care physicians and cardiologists. J Am Acad Dermatol 2012; 67: 357-362.

https://doi.org/10.1016/j.jaad.2011.09.006 DOI: https://doi.org/10.1016/j.jaad.2011.09.006

Manalo IF, Gilbert KE, Wu JJ. Survey of trends and gaps in dermatologists' cardiovascular screening practices in psoriasis patients: areas still in need of improvement. J Am Acad Dermatol 2015; 73: 872-874.e874.

https://doi.org/10.1016/j.jaad.2015.07.029 DOI: https://doi.org/10.1016/j.jaad.2015.07.029

Alamdari HS, Gustafson CJ, Davis SA, Huang W, Feldman SR. Psoriasis and cardiovascular screening rates in the United States. J Drugs Dermatol 2013; 12: e14-19.

Singh P, Silverberg JI. Screening for cardiovascular comorbidity in United States outpatients with psoriasis, hidradenitis, and atopic dermatitis. Arch Dermatol Res 2021; 313: 163-171.

https://doi.org/10.1007/s00403-020-02087-w DOI: https://doi.org/10.1007/s00403-020-02087-w

European Association of Preventive Cardiology. HeartScore. [Accessed 2022, April 1]. Available from: https://www.heartscore.org/en_GB/

American Heart Association. 2018 Prevention guidelines tool CV risk calculator. [Accessed 2022, April 1] Available from: https://static.heart.org/riskcalc/app/index.html#!/baseline-risk.

Mehta NN, Yu Y, Pinnelas R, Krishnamoorthy P, Shin DB, Troxel AB, et al. Attributable risk estimate of severe psoriasis on major cardiovascular events. Am J Med 2011; 124: 775.e1-775.e7756.

https://doi.org/10.1016/j.amjmed.2011.03.028 DOI: https://doi.org/10.1016/j.amjmed.2011.03.028

Gonzalez-Cantero A, Reddy AS, Dey AK, Gonzalez-Cantero J, Munger E, Rodante J, et al. Underperformance of clinical risk scores in identifying imaging-based high cardiovascular risk in psoriasis: results from two observational cohorts. Eur J Prev Cardiol 2022; 29: 591-598.

https://doi.org/10.1093/eurjpc/zwaa033 DOI: https://doi.org/10.1093/eurjpc/zwaa033

Barbieri JS, Mostaghimi A, Noe MH, Margolis DJ, Gelfand JM. Use of primary care services among patients with chronic skin disease seen by dermatologists. JAAD Int 2021; 2: 31-36.

https://doi.org/10.1016/j.jdin.2020.10.010 DOI: https://doi.org/10.1016/j.jdin.2020.10.010

Puig L, Ferrándiz C, Pujol RM, Vela E, Albertí-Casas C, Comellas M, et al. Burden of psoriasis in Catalonia: epidemiology, associated comorbidities, health care utilization, and sick leave. Actas Dermosifiliogr (Engl Ed) 2021; 112: 425-433. DOI: https://doi.org/10.1016/j.adengl.2021.02.011

https://doi.org/10.1016/j.ad.2020.11.017 DOI: https://doi.org/10.1016/j.ad.2020.11.017

Barbieri JS, Beidas RS, Gondo GC, Fishman J, Williams NJ, Armstrong AW, et al. Analysis of specialist and patient perspectives on strategies to improve cardiovascular disease prevention among persons with psoriatic disease. JAMA Dermatol 2022; 158: 252-259.

https://doi.org/10.1001/jamadermatol.2021.4467 DOI: https://doi.org/10.1001/jamadermatol.2021.4467

Published

2023-03-28

How to Cite

Berna-Rico, E., Abbad-Jaime de Aragon, C., Garcia-Aparicio, A., Palacios-Martinez, D., Ballester-Martinez, A., Carrascosa, J.-M., de la Cueva, P., Anton, C., Azcarraga-Llobet, C., Garcia-Mouronte, E., de Nicolas-Ruanes, B., Puig, L., Jaen, P., Mehta, N. N., Gelfand, J. M., & Gonzalez-Cantero, A. (2023). Cardiovascular Screening Practices and Statin Prescription Habits in Patients with Psoriasis among Dermatologists, Rheumatologists and Primary Care Physicians. Acta Dermato-Venereologica, 103, adv5087. https://doi.org/10.2340/actadv.v103.5087

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